US Pilot Study of Lumbar to Sacral Nerve Rerouting to Restore Voiding and Bowel Function in Spina Bifida: 3-Year Experience
Objective. To report our experience with creating a skin-central nervous system-bladder reflex arc with intradural lumbar to sacral motor root microanastomosis to restore bladder/bowel function in spina bifida patients. Methods. Urinary/bowel changes from baseline to three years were evaluated with...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Advances in Urology |
| Online Access: | http://dx.doi.org/10.1155/2014/863209 |
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| author | Kenneth M. Peters Holly Gilmer Kevin Feber Benjamin J. Girdler William Nantau Gary Trock Kim A. Killinger Judith A. Boura |
| author_facet | Kenneth M. Peters Holly Gilmer Kevin Feber Benjamin J. Girdler William Nantau Gary Trock Kim A. Killinger Judith A. Boura |
| author_sort | Kenneth M. Peters |
| collection | DOAJ |
| description | Objective. To report our experience with creating a skin-central nervous system-bladder reflex arc with intradural lumbar to sacral motor root microanastomosis to restore bladder/bowel function in spina bifida patients. Methods. Urinary/bowel changes from baseline to three years were evaluated with questionnaires, voiding diaries, urodynamics (UDS), and renal function studies. Treatment response was defined as CIC ≤ once/day with stable renal function, voiding efficiency > 50%, and no worsening of motor function. Results. Of 13 subjects (9 female, median age 8 years), 3 voided small amounts at baseline, one voided 200 cc (voiding efficiency 32%), 4/13 reported normal bowels, and 2/13 were continent of stool. Postoperatively, all had transient lower extremity weakness; one developed permanent foot drop. Over three years, renal function remained stable and mean maximum cystometric capacity (MCC) increased (P=0.0135). In the 10 that returned at 3 years, 7 were treatment responders and 9 had discontinued antimuscarinics, but most still leaked urine. Only 2/8 with baseline neurogenic detrusor overactivity (NDO) still had NDO, all 3 with compliance <10 mL/cm H2O had normalized, 7/10 considered their bowels normal, 5/10 were continent of stool, and 8/10 would undergo the procedure again. Conclusion. Lumbar to sacral nerve rerouting can improve elimination in spina bifida patients. This trial is registered with ClinicalTrials.gov NCT00378664. |
| format | Article |
| id | doaj-art-325c9cc2e0f34496ba462b04ecf5972d |
| institution | Kabale University |
| issn | 1687-6369 1687-6377 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Advances in Urology |
| spelling | doaj-art-325c9cc2e0f34496ba462b04ecf5972d2025-02-03T01:11:35ZengWileyAdvances in Urology1687-63691687-63772014-01-01201410.1155/2014/863209863209US Pilot Study of Lumbar to Sacral Nerve Rerouting to Restore Voiding and Bowel Function in Spina Bifida: 3-Year ExperienceKenneth M. Peters0Holly Gilmer1Kevin Feber2Benjamin J. Girdler3William Nantau4Gary Trock5Kim A. Killinger6Judith A. Boura7Beaumont Health System, Royal Oak, MI 48073, USABeaumont Health System, Royal Oak, MI 48073, USABeaumont Health System, Royal Oak, MI 48073, USAUrology Center of the Rockies, Fort Collins, CO 80528, USABeaumont Health System, Royal Oak, MI 48073, USABeaumont Health System, Royal Oak, MI 48073, USABeaumont Health System, Royal Oak, MI 48073, USABeaumont Health System, Royal Oak, MI 48073, USAObjective. To report our experience with creating a skin-central nervous system-bladder reflex arc with intradural lumbar to sacral motor root microanastomosis to restore bladder/bowel function in spina bifida patients. Methods. Urinary/bowel changes from baseline to three years were evaluated with questionnaires, voiding diaries, urodynamics (UDS), and renal function studies. Treatment response was defined as CIC ≤ once/day with stable renal function, voiding efficiency > 50%, and no worsening of motor function. Results. Of 13 subjects (9 female, median age 8 years), 3 voided small amounts at baseline, one voided 200 cc (voiding efficiency 32%), 4/13 reported normal bowels, and 2/13 were continent of stool. Postoperatively, all had transient lower extremity weakness; one developed permanent foot drop. Over three years, renal function remained stable and mean maximum cystometric capacity (MCC) increased (P=0.0135). In the 10 that returned at 3 years, 7 were treatment responders and 9 had discontinued antimuscarinics, but most still leaked urine. Only 2/8 with baseline neurogenic detrusor overactivity (NDO) still had NDO, all 3 with compliance <10 mL/cm H2O had normalized, 7/10 considered their bowels normal, 5/10 were continent of stool, and 8/10 would undergo the procedure again. Conclusion. Lumbar to sacral nerve rerouting can improve elimination in spina bifida patients. This trial is registered with ClinicalTrials.gov NCT00378664.http://dx.doi.org/10.1155/2014/863209 |
| spellingShingle | Kenneth M. Peters Holly Gilmer Kevin Feber Benjamin J. Girdler William Nantau Gary Trock Kim A. Killinger Judith A. Boura US Pilot Study of Lumbar to Sacral Nerve Rerouting to Restore Voiding and Bowel Function in Spina Bifida: 3-Year Experience Advances in Urology |
| title | US Pilot Study of Lumbar to Sacral Nerve Rerouting to Restore Voiding and Bowel Function in Spina Bifida: 3-Year Experience |
| title_full | US Pilot Study of Lumbar to Sacral Nerve Rerouting to Restore Voiding and Bowel Function in Spina Bifida: 3-Year Experience |
| title_fullStr | US Pilot Study of Lumbar to Sacral Nerve Rerouting to Restore Voiding and Bowel Function in Spina Bifida: 3-Year Experience |
| title_full_unstemmed | US Pilot Study of Lumbar to Sacral Nerve Rerouting to Restore Voiding and Bowel Function in Spina Bifida: 3-Year Experience |
| title_short | US Pilot Study of Lumbar to Sacral Nerve Rerouting to Restore Voiding and Bowel Function in Spina Bifida: 3-Year Experience |
| title_sort | us pilot study of lumbar to sacral nerve rerouting to restore voiding and bowel function in spina bifida 3 year experience |
| url | http://dx.doi.org/10.1155/2014/863209 |
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